This project will build on an AHRQ Partnerships for Quality planning grant awarded to The Leapfrog Group. The initial grant supported a multi-stakeholder effort to design financial incentives and rewards to speed the adoption of Leapfrog's recommended hospital patient safety practices: computerized physician order entry; evidence-based hospital referrals for select high risk conditions and procedures; and staffing intensive care units with trained specialists. The Leapfrog Group is a consortium of more than 135 large private and public health care purchasers who buy health benefits for more than 33 million Americans. Moving now to an implementation phase of the project, Leapfrog has devised a plan for conducting and rigorously evaluating financial incentive or reward pilots in up to 6 U.S. healthcare markets in two waves over the next three years. Leapfrog now seeks additional support from AHRQ to conduct this phase. With the guidance of Leapfrog's incentive and reward work group, which consists of hospital, health plan, physician, consumer and purchaser representatives, as well as actuarial support from Towers Perrin, and project management and health benefits contracting guidance from GE, these pilots will be led locally and vary in approach. Leapfrog will provide technical assistance through expert consultants, including actuarial (Towers Perrin), data analysis (The Medstat Group), and legal consulting (Ropes & Gray). Independent evaluators (Dennis Scanlon and Eric Ford of Pennsylvania State University and Jon Christianson of University of Minnesota) will help identify successful and unsuccessful strategies by monitoring the process each pilot site uses to implement its program and assessing each program's outcomes. Leapfrog will disseminate widely the lessons learned to all of its purchaser members as well as to other purchasers, health plans and hospitals.